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Micronutrients in HIV/AIDS

Pregnancy and Micronutrients

Micronutrient Requirement in HIV/AIDS

Micronutrient deficiencies are prevalent in many HIV-infected populations, and numerous studies have reported that these deficiencies impair immune responses, weaken epithelial integrity, and are associated with accelerated HIV disease progression. Strong evidence from observational studies has led to interest in the potential of micronutrient supplementation as a cost-effective strategy for preventing HIV disease progression in all stages of the disease.

According to the Department of Health, South Africa, several causes of poor nutrition in people living with HIV/AIDS have been highlighted[4]. These include:

• The virus caused increased need for energy and protein.

• Repeated infections and fever

• Loss of appetite

• Reduced food intake due to feeding problems

• Poor absorption of nutrients from foods

• Nutrient losses from urine and stools

• Medication

• Depression and anxiety

• Reduced ability to care for oneself

• Tiredness, even in early stages

• Access to and availability of food.

A combination of these factors cause poor nutrition and weight loss in people living with HIV/AIDS. This relationship therefore becomes cyclical as shown in the figure below:

HIV/AIDS lowers food intake:

• Infections and illness lead to poor appetite

• Mouth and throat infections cause difficulties in swallowing

• Some medicines cause poor sense of taste as a side effect

• Both expense of treatment and the inability to work affect income levels leading to less money being available for food.

• Depression fear and anxiety contribute to poor appetite

In addition, HIV/AIDS causes physical problems:

• Lining of the gut deteriorates affecting the ability of the gut to digest and absorb food.

• Malabsorption also caused by diarrhoea due to gut infections by different viral, bacterial and fungal diseases.

The need for micronutrients in HIV has been highlighted by numerous observational studies.

In a recent study carried out in Thailand, a wide spectrum micronutrient supplementation was found to reduce the risk of death in people with advanced HIV disease. People with CD4 counts between 101 and 200 cells/mm ³ who received the supplement in the placebo controlled study were 67% less likely to die during the 48 weeks of study. People with CD4 cell counts below 100 cells/mm ³ who received the supplement were 75% less likely to die. [1]

A large study conducted in South Africa found that a daily Vitamin B complex and multivitamin delayed the onset of AIDS and death. [2]

In addition, a broad spectrum micronutrient formulated in California has been shown to significantly increase CD4 cells counts – by 25% over 12 weeks – when used as an adjunct therapy to HAART. The micronutrient was tested in a randomised and placebo-controlled study involving 40 HIV-infected people. [3]

In the Sub-Saharan setting general multivitamins are occasionally given as nutritional supplements for HIV disease. However the common available vitamins are internationally branded products that are way too expensive for the HIV patient. This is usually an additional cost to the HAART therapy, thus making it a distant priority to the mainstream medication.

There is therefore need for cost-effective, clinically tested multivitamin that can be used for HIV/AIDS patients. Essentials® has specially been formulated with these factors in mind. It offers a clinically proven daily dosage of various micronutrients that have been tested and shown to be beneficial in HIV/AIDS disease.

This guide brings into perspective a concise and summarized version of those nutritional requirements. It clarifies the most widely studied micronutrients including selenium, Vit B1 (Thiamine), Vit B6 (Pyridoxine), Vit B 12 (Cobalamine), Vitamin E (Tocopherol), Vitamin A, Magnesium and Zinc.

References

[1]Jimton S et al. A randomized trial of the impact of multiple micronutrient supplementation on mortality among HIV-infected individuals living in Bangok . AIDS 17:2461-2469, 2003
[2] Kanter AS et al. Supplemental vitamin B and progression to AIDS and death in black South African patients infected with HIV. Letter. Journal of AIDS 21(3):252-253, 1999.
[3] Kaiser J et al. Broad-spectrum micronutrient supplementation in HIV-infected patients with dideoxynucleoside-related peripheral neuropath: a prospective, double-blind, placebo-controlled trial. Eleventh conference on Retroviruses and Opportunistic infections, San Francisco, abstract 494, 2004
[4] South African National Guidelines on Nutrition for People living with TB, HIV/AIDS and other Chronic Debilitating Conditions. Department of Health , (2001)